Meyer (China)

Clinicians, staff, patients, and visitors use the healthcare environment, and a deeper understanding of spatial elements that promote their well-being is necessary. However, clinical and academic nursing does not naturally fit within the field of architectural design and planning. A design charrette, an interactive and innovative approach for faculty, staff, and clinicians, offers participants a chance to be creative in merging evidence-based practice with evidence-based design principles to aid in well-being. This educational brief outlines the process and outcomes of spaces that promote well-being and restoration. The design example presented is a restorative space in a clinical unit. We describe the methods of this teaching experience and highlight the application of a design charrette for a clinical unit.

The newborn's skin must undergo a transition process as a result of the passage from an aqueous to an aerobic environment. This process occurs over a period of approximately 2 to 8 weeks. The skin of newborns has important anatomical and physiological differences compared to those of older children and adults. It is thin, with fewer appendages; the stratum corneum is not present; the dermal-epidermal junction is reduced; intercellular junctions are weaker; the secretions of the sebaceous glands are limited and the pH is generally neutral. All these factors make the newborn's skin more fragile to any stimulus. To have effective prevention and intervention procedures, an accurate and practical risk assessment tool should be identified as a preliminary step for adequate prevention. Unfortunately, only few validated tools are available to assess the risk of PUs in children, especially newborns. The objective of the study is to examine the adherence of the most used tools for the assessment of PU risk in newborns, in particular to make a comparison of the limits and advantages of the most frequently used tools in neonatal settings, the Glamorgan scale and NSRAS. To respond to the main objective, a scoping review of the literature was conducted. 54 studies were identified. Further analysis was conducted, which led to the exclusion of articles that did not examine the characteristics of newborn skin, the risk factors related to PUs and the appropriateness of the NSRAS and Glamorgan tools, for a final selection of 35 studies. Patients admitted to NICU represent the paediatric category most exposed to the risk of developing pressure ulcers. Factors such as reduced mobility, together with the pressure exerted by aids or devices, increase the risk of pressure injuries. The risk factors that most expose the newborn to risk are the structure of the skin and medical devices. Nurses should implement preventative measures to control the risk of PU. The use of specific tools is necessary to detect the risk of PUs in newborns and implement preventive measures. PUs risk assessment is one of the nursing care strategies for prevention. Therefore, operators need a valid, reliable, and predictive scale. Lastly, we recommend the use of NSRAS for future research and for the education of healthcare professionals in the neonatal area.

Large language models (LLMs) are crucial for medical tasks. Ensuring their reliability is vital to avoid false results. Our study assesses two state-of-the-art LLMs (ChatGPT and LlaMA-2) for extracting clinical information, focusing on cognitive tests like MMSE and CDR. Evaluate ChatGPT and LlaMA-2 performance in extracting MMSE and CDR scores, including their associated dates. Our data consisted of 135,307 clinical notes (Jan 12th, 2010 to May 24th, 2023) mentioning MMSE, CDR, or MoCA. After applying inclusion criteria 34,465 notes remained, of which 765 underwent ChatGPT (GPT-4) and LlaMA-2, and 22 experts reviewed the responses. ChatGPT successfully extracted MMSE and CDR instances with dates from 742 notes. We used 20 notes for fine-tuning and training the reviewers. The remaining 722 were assigned to reviewers, with 309 each assigned to two reviewers simultaneously. Inter-rater-agreement (Fleiss' Kappa), precision, recall, true/false negative rates, and accuracy were calculated. Our study follows TRIPOD reporting guidelines for model validation. For MMSE information extraction, ChatGPT (vs. LlaMA-2) achieved accuracy of 83% (vs. 66.4%), sensitivity of 89.7% (vs. 69.9%), true-negative rates of 96% (vs 60.0%), and precision of 82.7% (vs 62.2%). For CDR the results were lower overall, with accuracy of 87.1% (vs. 74.5%), sensitivity of 84.3% (vs. 39.7%), true-negative rates of 99.8% (98.4%), and precision of 48.3% (vs. 16.1%). We qualitatively evaluated the MMSE errors of ChatGPT and LlaMA-2 on double-reviewed notes. LlaMA-2 errors included 27 cases of total hallucination, 19 cases of reporting other scores instead of MMSE, 25 missed scores, and 23 cases of reporting only the wrong date. In comparison, ChatGPT's errors included only 3 cases of total hallucination, 17 cases of wrong test reported instead of MMSE, and 19 cases of reporting a wrong date. In this diagnostic/prognostic study of ChatGPT and LlaMA-2 for extracting cognitive exam dates and scores from clinical notes, ChatGPT exhibited high accuracy, with better performance compared to LlaMA-2. The use of LLMs could benefit dementia research and clinical care, by identifying eligible patients for treatments initialization or clinical trial enrollments. Rigorous evaluation of LLMs is crucial to understanding their capabilities and limitations.

Control of cell identity and number is central to tissue function, yet principles governing organization of malignant cells in tumor tissues remain poorly understood. Using mathematical modeling and candidate-based analysis, we discover primary and metastatic pancreatic ductal adenocarcinoma (PDAC) organize in a stereotypic pattern whereby PDAC cells responding to WNT signals (WNT-R) neighbor WNT-secreting cancer cells (WNT-S). Leveraging lineage-tracing, we reveal the WNT-R state is transient and gives rise to the WNT-S state that is highly stable and committed to organizing malignant tissue. We further show that a subset of WNT-S cells expressing the Notch ligand DLL1 form a functional niche for WNT-R cells. Genetic inactivation of WNT secretion or Notch pathway components, or cytoablation of the WNT-S state disrupts PDAC tissue organization, suppressing tumor growth and metastasis. This work indicates PDAC growth depends on an intricately controlled equilibrium of functionally distinct cancer cell states, uncovering a fundamental principle governing solid tumor growth and revealing new opportunities for therapeutic intervention.

A anemia por Deficiência de Piruvato Quinase (PK) tem como característica ser autossômica e recessiva, sendo a segunda causa mais comum na classificação de anemias por defeito enzimático, após a deficiência por G6PD. OBJETIVO: O objetivo desta pesquisa foi esclarecer a fisiopatologia da anemia de PK. METODOLOGIA: Foi realizada uma pesquisa de revisão bibliográfica em meio eletrônico no banco de dados de artigos do Scielo, no período de 2006 a 2009, nos idiomas Inglês e Português. Foram utilizados 2 artigos e 1 livro. Através das palavras chaves: anemia, deficiência enzimática, anemia por deficiência de PK. RESULTADOS: As mutações ocorrem no gene PKLR (1q22), que é ativado no fígado e nos glóbulos vermelhos, onde fornece instruções para fazer uma enzima chamada piruvato quinase, que está envolvida no processo de produção de energia. Durante a glicólise, a glicose de açúcar simples é quebrada para produzir adenosina trifosfato (ATP), a principal fonte de energia da célula. As mutações do gene PKLR resultam na redução da função da enzima piruvato-quinase, causando uma escassez de ATP nos glóbulos vermelhos. Os glóbulos vermelhos anormais são recolhidos pelo baço e destruídos, liberando ferro e bilirrubina resultando em um excesso destas substâncias no sangue, que pode causar icterícia e aumenta o risco de desenvolver cálculos biliares. Em algumas condições médicas, a deficiência de piruvato quinase pode ser adquirida tais como: leucemia aguda, pré-leucemia, e complicações de quimioterapia, este tipo é mais comum e mais suave do que o tipo hereditário. Os eritrócitos dependem da glicose como fonte de energia. A glicose é geralmente metabolizada para piruvato e lactato na via Embden-Meyerhof. CONCLUSÃO: Portanto, pode-se constatar que a Anemia por Deficiência de PK é rara, mas através do entendimento da sua fisiopatologia, é possível reconhecer a mesma e procurar o tratamento que melhor auxiliará.

Cette étude s’intéresse au sort des femmes criminelles dans la Rome antique. La plupart du temps, à Rome, même lorsque la femme tombait sous le coup d’une condamnation publique, la question de l’administration de son châtiment était souvent transmise à la sphère privée, afin que la plus grande discrétion soit de mise. Le secret régnait donc en maître lorsqu’il s’agissait de crimes tels que l’adultère ou la consommation de vin : le problème était réglé au sein de la maison, par le mari, ou éventuellement des membres de la famille. L’intérêt, ici, est donc de comprendre les raisons d’un tel secret entourant le châtiment réservé à la femme criminelle et de voir si, dans certains cas, cette discrétion s’effaçait au profit d’une peine publique et si le secret pouvait parfois être rompu.

The prevalence of behavioral health disorders in children is approximately 15%-20%, yet less than half of the children ever receive treatment for these conditions. The lack of access to behavioral health care is common in urban areas but even more difficult to access in rural areas. Screening for behavioral health in a primary care setting is one of the first strategies to reduce this problem and improve access to care. The primary goal of this study was to examine behavioral health screening practices of pediatric primary care providers in a rural midwestern state. A survey that queried family practice/internal medicine and pediatric providers who provide care to pediatric patients was delivered to over 300 primary care providers across the state. The number of surveys returned was 112. The Modified Checklist for Autism tool was administered by 80% of pediatric providers and 30% of family practice primary care providers. The Patient Health Questionnaire for depression was administered by 72% of pediatric and 80% of family practice providers. Most of the primary care providers had a behavioral health provider present in the clinic, which likely resulted in higher screening rates compared to the national average. The screening practices of the family practice and pediatric subspecialities reflect their respective current professional organization recommendations. Although most providers believe it is important to screen for developmental and behavioral disorders, further system changes are needed to support screening for development and broader behavioral problems along with depression among family practice providers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Rationale: Although clinical trials have found that pulmonary rehabilitation (PR) can reduce the risk of readmissions after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, less is known about PR’s impact in routine clinical practice. Objectives: To evaluate the association between initiation of PR within 90 days of discharge and rehospitalization(s). Methods: We analyzed a retrospective cohort of Medicare beneficiaries (66 years of age or older) hospitalized for COPD in 2014 who survived at least 30 days after discharge. Measurements and Main Results: We used propensity score matching and estimated the risk of recurrent all-cause rehospitalizations at 1 year using a multistate model to account for the competing risk of death. Of 197,376 total patients hospitalized in 4,446 hospitals, 2,721 patients (1.5%) initiated PR within 90 days of discharge. Overall, 1,534 (56.4%) patients who initiated PR and 125,720 (64.6%) who did not were rehospitalized one or more times within 1 year of discharge. In the propensity-score–matched analysis, PR initiation was associated with a lower risk of readmission in the year after PR initiation (hazard ratio, 0.83; 95% confidence interval, 0.77–0.90). The mean cumulative number of rehospitalizations at 1 year was 0.95 for those who initiated PR within 90 days and 1.15 for those who did not (P < 0.001). Conclusions: After hospitalization for COPD, Medicare beneficiaries who initiated PR within 90 days of discharge experienced fewer rehospitalizations over 1 year. These results support findings from randomized controlled clinical trials and highlight the need to identify effective strategies to increase PR participation.

Tumors frequently exhibit aberrant glycosylation, which can impact cancer progression and therapeutic responses. The hexosamine biosynthesis pathway (HBP) produces uridine diphosphate N-acetylglucosamine (UDP-GlcNAc), a major substrate for glycosylation in the cell. Prior studies have identified the HBP as a promising therapeutic target in pancreatic ductal adenocarcinoma (PDA). The HBP requires both glucose and glutamine for its initiation. The PDA tumor microenvironment is nutrient poor, however, prompting us to investigate how nutrient limitation impacts hexosamine synthesis. Here, we identify that glutamine limitation in PDA cells suppresses de novo hexosamine synthesis but results in increased free GlcNAc abundance. GlcNAc salvage via N-acetylglucosamine kinase (NAGK) is engaged to feed UDP-GlcNAc pools. NAGK expression is elevated in human PDA, and NAGK deletion from PDA cells impairs tumor growth in mice. Together, these data identify an important role for NAGK-dependent hexosamine salvage in supporting PDA tumor growth.

An industrially proven method for increasing cell efficiency of monocrystalline P‐type PERC cells is reported, whereby a layer of silicon oxide or silicon oxynitride (SiO x /SiO x N y ) is sandwiched between aluminum oxide (AlO x ) and silicon nitride (SiN x ) in the rear passivation stack, forming an AlO x + SiO x /SiO x N y + SiN x structure. This additional layer will theoretically improve the rear side optical and electrical properties for the cell. By adjusting the flow ratio of N2O:NH3, SiO x /SiO x N y with different refractive indices were fabricated. Optimization of the SiO x film thickness showed a 0.11% efficiency gain in monofacial P‐type PERC cells because of higher short‐circuit current (I sc) and fill factor (FF), whereas optimization of the SiO x N y film refractive index showed a 0.05% efficiency gain in bifacial P‐type PERC cells due to the improvement of I sc and FF too. The current gain is believed to be benefited from the optimized light‐absorbing performance of the composite passivation layer structure. Furthermore, it is demonstrated that the refractive index of the SiN x capping layer had to be tuned after the incorporation of SiO x /SiO x N y to improve the cell efficiency.